Hemoptysis diagnostic study of choice: Difference between revisions
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== Overview == | == Overview == | ||
The initial diagnostic study in a patient with hemoptysis is [[Chest X-ray|chest x-ray]]. If diagnosis is not found on [[Chest X-ray|chest x-ray]], the next step is to perform [[High Resolution CT|high resolution CT scan]] or [[bronchoscopy]]. [[High Resolution CT|HRCT]] is better for diagnosis of [[bronchiectasis]] or [[Lung cancer|lung carcinoma]]. Flexible [[bronchoscopy]] is better for diagnosis of [[Mucous membrane|mucosal]] abnormalities such as [[bronchitis]], Dieulafoy disease or [[Kaposi's sarcoma|kaposi sarcoma]]. | |||
== Diagnostic Study of Choice == | == Diagnostic Study of Choice == | ||
=== Study of choice === | === Study of choice === | ||
* The initial diagnostic study in a patient with hemoptysis is [[Chest X-ray|chest x-ray]]. | * The initial diagnostic study in a patient with hemoptysis is [[Chest X-ray|chest x-ray]].<ref name="KhalilFedida2015">{{cite journal|last1=Khalil|first1=A.|last2=Fedida|first2=B.|last3=Parrot|first3=A.|last4=Haddad|first4=S.|last5=Fartoukh|first5=M.|last6=Carette|first6=M.-F.|title=Severe hemoptysis: From diagnosis to embolization|journal=Diagnostic and Interventional Imaging|volume=96|issue=7-8|year=2015|pages=775–788|issn=22115684|doi=10.1016/j.diii.2015.06.007}}</ref> | ||
* [[Chest X-ray|Chest x-ray]] might show underlying cause. However, it might be normal as well. | * [[Chest X-ray|Chest x-ray]] might show underlying cause. However, it might be normal as well.<ref name="Andersen2016">{{cite journal|last1=Andersen|first1=P. E.|title=Imaging and interventional radiological treatment of hemoptysis|journal=Acta Radiologica|volume=47|issue=8|year=2016|pages=780–792|issn=0284-1851|doi=10.1080/02841850600827577}}</ref> | ||
* The next step is to perform [[High Resolution CT|high resolution CT scan]] or [[bronchoscopy]]. | * The next step is to perform [[High Resolution CT|high resolution CT scan]] or [[bronchoscopy]].<ref name="LeeKim2015">{{cite journal|last1=Lee|first1=Myoung Kyu|last2=Kim|first2=Sang-Ha|last3=Yong|first3=Suk Joong|last4=Shin|first4=Kye Chul|last5=Kim|first5=Hyun Sik|last6=Yu|first6=Tae-Sun|last7=Choi|first7=Eun Hee|last8=Lee|first8=Won-Yeon|title=Moderate hemoptysis: recurrent hemoptysis and mortality according to bronchial artery embolization|journal=The Clinical Respiratory Journal|volume=9|issue=1|year=2015|pages=53–64|issn=17526981|doi=10.1111/crj.12104}}</ref> | ||
* [[High Resolution CT|HRCT]] is better in some conditions, such as: | * [[High Resolution CT|HRCT]] is better in some conditions, such as:<ref name="GuptaSrivastava2013">{{cite journal|last1=Gupta|first1=Mudit|last2=Srivastava|first2=Deep Narayan|last3=Seith|first3=Ashu|last4=Sharma|first4=Sanjay|last5=Thulkar|first5=Sanjay|last6=Gupta|first6=Rashmi|title=Clinical Impact of Multidetector Row Computed Tomography Before Bronchial Artery Embolization in Patients With Hemoptysis: A Prospective Study|journal=Canadian Association of Radiologists Journal|volume=64|issue=1|year=2013|pages=61–73|issn=08465371|doi=10.1016/j.carj.2011.08.002}}</ref><ref name="NoëJaffé2011">{{cite journal|last1=Noë|first1=G.D.|last2=Jaffé|first2=S.M.|last3=Molan|first3=M.P.|title=CT and CT angiography in massive haemoptysis with emphasis on pre-embolization assessment|journal=Clinical Radiology|volume=66|issue=9|year=2011|pages=869–875|issn=00099260|doi=10.1016/j.crad.2011.03.001}}</ref> | ||
** [[Bronchiectasis]] | ** [[Bronchiectasis]] | ||
** [[Carcinoma|Carcinomas]] | ** [[Carcinoma|Carcinomas]] | ||
* Flexible [[bronchoscopy]] is better in some conditions, such as: | * Flexible [[bronchoscopy]] is better in some conditions, such as:<ref name="SakrDutau2010">{{cite journal|last1=Sakr|first1=L.|last2=Dutau|first2=H.|title=Massive Hemoptysis: An Update on the Role of Bronchoscopy in Diagnosis and Management|journal=Respiration|volume=80|issue=1|year=2010|pages=38–58|issn=1423-0356|doi=10.1159/000274492}}</ref> | ||
** | ** [[Mucous membrane|Mucosal]] abnormalities including: | ||
*** [[Bronchitis]] | *** [[Bronchitis]] | ||
*** Dieulafoy disease | *** Dieulafoy disease | ||
*** [[Kaposi's sarcoma|Kaposi sarcoma]] | *** [[Kaposi's sarcoma|Kaposi sarcoma]] | ||
==Diagnosis of Mild to Moderate Hemoptysis== | |||
The algorithm is based on the American Family Physician Journal of hemoptysis: Diagnosis and Management <ref>name="pmid16225028">{{cite journal| author=Bidwell JL, Pachner RW| title=Hemoptysis: diagnosis and management. | journal=Am Fam Physician | year= 2005 | volume= 72 | issue= 7 | pages= 1253-60 | pmid=16225028 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16225028 }} </ref> | |||
{{Family tree/start}} | |||
{{familytree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | | | | | A01= <u>'''Hemoptysis'''</u>}} | |||
{{familytree | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|.| | | | | | | | | | | |}} | |||
{{familytree | | | | | B01 | | | | | | | | | | | | | B02 | | | | | | | | | | |B01= <u>'''Mild hemoptysis'''</u> <br> ❑ <30 cc in 24 hours <ref> name="pmid12243312">{{cite journal| author=Fidan A, Ozdoğan S, Oruç O, Salepçi B, Ocal Z, Cağlayan B| title=Hemoptysis: a retrospective analysis of 108 cases. | journal=Respir Med | year= 2002 | volume= 96 | issue= 9 | pages= 677-80 | pmid=12243312 | doi= | pmc= |url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12243312 }} </ref> | B02= <u>'''Moderate hemoptysis'''</u> <br> ❑ 30-200 cc in 24 hours <ref> name="pmid12243312">{{cite journal| author=Fidan A, Ozdoğan S, Oruç O, Salepçi B, Ocal Z, Cağlayan B| title=Hemoptysis: a retrospective analysis of 108 cases. | journal=Respir Med | year= 2002 | volume= 96 | issue= 9 | pages= 677-80 | pmid=12243312 | doi= | pmc=|url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12243312 }} </ref> }} | |||
{{familytree | | | | | |!| | | | | | | | | | | | | | |!| | | | | | | | | | | |}} | |||
{{familytree | | | | | C01 | | | | | | | | | | | | | C02 | | | | | | | | | | |C01= [[Chest X-ray]] (CXR) | C02= [[Chest X-ray]] and CT }} | |||
{{familytree | |,|-|-|-|^|-|-|-|.| | | | | | |,|-|-|-|^|-|-|-|.| | | | | | | |}} | |||
{{familytree | D01 | | | | | | D02 | | | | | D03 | | | | | | D04 | | | | | | |D01= Diagnose found | D02= Diagnose unknown | D03= Diagnose found | D04= Diagnose unknown}} | |||
{{familytree | |!| | | | | | | |!| | | | | | |!| | | | | | | |!| | | | | | | |}} | |||
{{familytree | E01 | | | | | | E02 | | | | | E03 | | | | | | E04 | | | | | | |E01= Treat underlying disease | E02= <div style="float: left; text-align: left; height: 10em; width: 12em; padding:1em;"> '''Risk of malignancy'''<ref name="pmid22158327">{{cite journal| author=Parkin DM, Boyd L, Walker LC| title=16. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010. | journal=Br J Cancer | year= 2011 | volume= 105 Suppl 2 | issue= | pages= S77-81 | pmid=22158327 | doi=10.1038/bjc.2011.489 | pmc=PMC3252065 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22158327 }} </ref><br> | |||
❑ [[Smoking]] <br> | |||
❑ Occupational exposure <br> | |||
❑ Family history <br> | |||
❑ Previous cancer treatment </div> | E03= Treat underlying disease | E04= Bronchoscopy to find diagnosis}} | |||
{{familytree | | | | | |,|-|-|-|^|-|-|-|.| | | | | | |,|-|-|-|^|-|-|-|.| | | |}} | |||
{{familytree | | | | | F01 | | | | | | F02 | | | | | F03 | | | | | | F04 | | | F01= Yes | F02= No | F03= Diagnose found | F04= Diagnose unknown}} | |||
{{familytree | | | | | |!| | | | | | | |!| | | | | | |!| | | | | | | |!| | | |}} | |||
{{familytree | | | | | G01 | | | | | | G02 | | | | | G03 | | | | | | G04 | | | G01= [[CT]] or [[bronchoscopy]] to find diagnosis| G02= Close monitoring | G03= Treat underlying disease | G04= Close monitoring}} | |||
{{familytree | |,|-|-|-|^|-|-|-|.| | | |!| | | | | | | | | | | | | | | | | | |}} | |||
{{familytree | H01 | | | | | | H02 | | H03 | | | | | | | | | | | | | | | | | | H01= Diagnose found | H02= Diagnose unknown | H03= If hemoptysis persist consult with pneumonologist}} | |||
{{familytree | |!| | | | | | | |!| | | | | | | | | | | | | | | | | | | | | | |}} | |||
{{familytree | I01 | | | | | | I02 | | | | | | | | | | | | | | | | | | | | | |I01= Treat underlying Disease | I02= Close monitoring}} | |||
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}} | |||
{{Family tree/end}} | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Medicine]] | |||
[[Category:Gastroenterology]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Radiology]] | |||
[[Category:Emergency medicine]] | |||
Latest revision as of 22:02, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]
Overview
The initial diagnostic study in a patient with hemoptysis is chest x-ray. If diagnosis is not found on chest x-ray, the next step is to perform high resolution CT scan or bronchoscopy. HRCT is better for diagnosis of bronchiectasis or lung carcinoma. Flexible bronchoscopy is better for diagnosis of mucosal abnormalities such as bronchitis, Dieulafoy disease or kaposi sarcoma.
Diagnostic Study of Choice
Study of choice
- The initial diagnostic study in a patient with hemoptysis is chest x-ray.[1]
- Chest x-ray might show underlying cause. However, it might be normal as well.[2]
- The next step is to perform high resolution CT scan or bronchoscopy.[3]
- HRCT is better in some conditions, such as:[4][5]
- Flexible bronchoscopy is better in some conditions, such as:[6]
- Mucosal abnormalities including:
- Bronchitis
- Dieulafoy disease
- Kaposi sarcoma
- Mucosal abnormalities including:
Diagnosis of Mild to Moderate Hemoptysis
The algorithm is based on the American Family Physician Journal of hemoptysis: Diagnosis and Management [7]
| Hemoptysis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Mild hemoptysis ❑ <30 cc in 24 hours [8] | Moderate hemoptysis ❑ 30-200 cc in 24 hours [9] | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Chest X-ray (CXR) | Chest X-ray and CT | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Diagnose found | Diagnose unknown | Diagnose found | Diagnose unknown | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Treat underlying disease | Treat underlying disease | Bronchoscopy to find diagnosis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Yes | No | Diagnose found | Diagnose unknown | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| CT or bronchoscopy to find diagnosis | Close monitoring | Treat underlying disease | Close monitoring | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Diagnose found | Diagnose unknown | If hemoptysis persist consult with pneumonologist | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Treat underlying Disease | Close monitoring | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
References
- ↑ Khalil, A.; Fedida, B.; Parrot, A.; Haddad, S.; Fartoukh, M.; Carette, M.-F. (2015). "Severe hemoptysis: From diagnosis to embolization". Diagnostic and Interventional Imaging. 96 (7–8): 775–788. doi:10.1016/j.diii.2015.06.007. ISSN 2211-5684.
- ↑ Andersen, P. E. (2016). "Imaging and interventional radiological treatment of hemoptysis". Acta Radiologica. 47 (8): 780–792. doi:10.1080/02841850600827577. ISSN 0284-1851.
- ↑ Lee, Myoung Kyu; Kim, Sang-Ha; Yong, Suk Joong; Shin, Kye Chul; Kim, Hyun Sik; Yu, Tae-Sun; Choi, Eun Hee; Lee, Won-Yeon (2015). "Moderate hemoptysis: recurrent hemoptysis and mortality according to bronchial artery embolization". The Clinical Respiratory Journal. 9 (1): 53–64. doi:10.1111/crj.12104. ISSN 1752-6981.
- ↑ Gupta, Mudit; Srivastava, Deep Narayan; Seith, Ashu; Sharma, Sanjay; Thulkar, Sanjay; Gupta, Rashmi (2013). "Clinical Impact of Multidetector Row Computed Tomography Before Bronchial Artery Embolization in Patients With Hemoptysis: A Prospective Study". Canadian Association of Radiologists Journal. 64 (1): 61–73. doi:10.1016/j.carj.2011.08.002. ISSN 0846-5371.
- ↑ Noë, G.D.; Jaffé, S.M.; Molan, M.P. (2011). "CT and CT angiography in massive haemoptysis with emphasis on pre-embolization assessment". Clinical Radiology. 66 (9): 869–875. doi:10.1016/j.crad.2011.03.001. ISSN 0009-9260.
- ↑ Sakr, L.; Dutau, H. (2010). "Massive Hemoptysis: An Update on the Role of Bronchoscopy in Diagnosis and Management". Respiration. 80 (1): 38–58. doi:10.1159/000274492. ISSN 1423-0356.
- ↑ name="pmid16225028">Bidwell JL, Pachner RW (2005). "Hemoptysis: diagnosis and management". Am Fam Physician. 72 (7): 1253–60. PMID 16225028.
- ↑ name="pmid12243312">Fidan A, Ozdoğan S, Oruç O, Salepçi B, Ocal Z, Cağlayan B (2002). "Hemoptysis: a retrospective analysis of 108 cases". Respir Med. 96 (9): 677–80. PMID 12243312.
- ↑ name="pmid12243312">Fidan A, Ozdoğan S, Oruç O, Salepçi B, Ocal Z, Cağlayan B (2002). "Hemoptysis: a retrospective analysis of 108 cases". Respir Med. 96 (9): 677–80. PMID 12243312.
- ↑ Parkin DM, Boyd L, Walker LC (2011). "16. The fraction of cancer attributable to lifestyle and environmental factors in the UK in 2010". Br J Cancer. 105 Suppl 2: S77–81. doi:10.1038/bjc.2011.489. PMC 3252065. PMID 22158327.